A network meta-analysis shows that atezolizumab plus bevacizumab is considered the standard first-line therapy option for patients with advanced hepatocellular carcinoma (HCC); regorafenib and cabozantinib are preferred options in refractory patients, according to an analysis published in JAMA Oncology (2020;e204930. doi:10.1001/jamaoncol.2020.4930).
“The treatment landscape for advanced [HCC] has recently changed and become relatively confusing. Head-to-head comparisons between most of the available agents have not been performed and are less likely to be examined in a prospective fashion in the future,” explained Mohamad Bassam Sonbol, MD, Mayo Clinic Cancer Center, Phoenix, Arizona, and colleagues.
This systematic review and network meta-analysis evaluated the comparative effectiveness of different systemic treatments in advanced HCC across lines of therapy.
Various databases were searched for abstracts and full-text articles published from database inception through March 2020. Phase 3 trials evaluating different vascular endothelial growth factor inhibitors (VEGFis), checkpoint inhibitors (CPIs), or their combinations in HCC were included.
The main outcomes and measures included the overall survival and progression-free survival.
In patients with HCC treated in the first-line setting, network meta-analysis showed that the combination of atezolizumab and bevacizumab was better when compared with lenvatinib (HR, 0.63; 95% CI, 0.44-0.89), sorafenib (HR, 0.58; 95% CI, 0.42-0.80), and nivolumab (HR, 0.68; 95% CI, 0.48-0.98). All studied drugs had progression free survival benefit compared with placebo in the refractory setting. An overall survival benefit was found with regorafenib (HR, 0.62; 95% CI, 0.51-0.75) and cabozantinib (HR, 0.76; 95% CI, 0.63-0.92) compared with placebo.
“This systematic review and [network meta-analysis] of 14 trials found that atezolizumab and bevacizumab in combination is now considered the standard of care in the first-line setting in patients with advanced HCC. Regorafenib and cabozantinib are preferred options in refractory patients, with ramucirumab as an additional option in those with levels of AFP of 400 ng/mL or higher,” Dr Sonbol and colleagues concluded.
“Future trials should focus on other potential combinations and best treatment strategy in patients with prior VEGFi/CPI exposure,” they added.—Lisa Kuhns
